Position in the second stage of labour for women without epidural anaesthesia

Gupta JK, Hofmeyr GJ, Smyth RMD

Published Online:

October 7, 2009

Women should be encouraged to give birth in comfortable positions, which are usually upright.

In traditional cultures, women naturally give birth in upright positions like kneeling, standing etc. In western societies, doctors have influenced women to give birth on their backs, sometimes with their legs up in stirrups. The review of trials found the studies were not of good quality, but they showed that when women gave birth on their backs it was more painful for the mother and caused more problems with the baby's heartbeat. More women needed help from doctors using forceps and more had cuts to the birth outlet, but there was less blood loss. More research is needed.

Abstract (click to read)

Background:

For centuries, there has been controversy around whether being upright (sitting, birthing stools, chairs, squatting) or lying down have advantages for women delivering their babies.

Objectives:

To assess the benefits and risks of the use of different positions during the second stage of labour (i.e. from full dilatation of the cervix).

Search strategy:

We searched the Cochrane Pregnancy and Childbirth Group Trials Register (30 September 2005). We updated this search on 12 June 2009 and added the results to the awaiting classification section.

Selection criteria:

Trials that used randomised or quasi-randomised allocation and appropriate follow up and compared various positions assumed by pregnant women during the second stage of labour.

Data collection and analysis:

We independently assessed the trials for inclusion and extracted the data.

Main results:

Results should be interpreted with caution as the methodological quality of the 20 included trials (6135 participants) was variable. Use of any upright or lateral position, compared with supine or lithotomy positions, was associated with: reduced duration of second stage of labour (9 trials: mean 4.28 minutes, 95% confidence interval (CI) 2.93 to 5.63 minutes) - this was largely due to a considerable reduction in women allocated to the use of the birth cushion; a small reduction in assisted deliveries (19 trials: relative risk (RR) 0.80, 95% CI 0.69 to 0.92); a reduction in episiotomies (12 trials: RR 0.83, 95% CI 0.75 to 0.92); an increase in second degree perineal tears (11 trials: RR 1.23, 95% CI 1.09 to 1.39); increased estimated blood loss greater than 500 ml (11 trials: RR 1.63, 95% CI 1.29 to 2.05); reduced reporting of severe pain during second stage of labour (1 trial: RR 0.73, 95% CI 0.60 to 0.90); fewer abnormal fetal heart rate patterns (1 trial: RR 0.31, 95% CI 0.08 to 0.98).

Authors' conclusions:

The tentative findings of this review suggest several possible benefits for upright posture, with the possibility of increased risk of blood loss greater than 500 ml. Women should be encouraged to give birth in the position they find most comfortable. Until such time as the benefits and risks of various delivery positions are estimated with greater certainty, when methodologically stringent trials' data are available, women should be allowed to make informed choices about the birth positions in which they might wish to assume for delivery of their babies.

[Note: The four citations in the awaiting assessment section of the review may alter the conclusions of the review once assessed.]

This record should be cited as:

Gupta JK, Hofmeyr GJ, Smyth RMD. Position in the second stage of labour for women without epidural anaesthesia. Cochrane Database of Systematic Reviews 2000, Issue 1. Art. No.: CD002006. DOI: 10.1002/14651858.CD002006.pub2

Assessed as up to date:

September 30, 2005

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Primary Review Group:

Pregnancy and Childbirth Group

Health topics:

Pregnancy & childbirth > Care during childbirth > Normal labour & birth

Demographic:

Women

Cochrane group topics:

Pregnancy and Childbirth > Care during childbirth > Normal birth > Second stage

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Position in the second stage of labour for women without epidural anaesthesia

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